You pay copays for doctor and specialist office visits, certain other expenses and prescription drugs; all other expenses apply to the deductible—you pay the expense in full until you meet the deductible

After you meet the annual deductible: You and The University share the cost of care through copays and coinsurance

After you meet the medical annual out-of-pocket maximum: Plan pays 100% of all covered expenses for the rest of the Plan Year

Benefits are not paid for services received from non-network providers, except in emergencies

Pay the least out-of-pocket of all the medical options when you receive care from in-network providers

You pay copays for doctor and specialist office visits, certain other expenses and prescription drugs; all other expenses apply to the deductible—you pay the expense in full until you meet the deductible

After you meet the annual deductible: You and The University share the cost of care through copays and coinsurance

After you meet the medical annual out-of-pocket maximum: Plan pays 100% of all eligible expenses for the rest of the Plan Year

You can see an out-of-network providers but you will pay more for care

UMR Disease Management Programs

UMR—the medical plan administrator—offers disease management programs to help you and your family members deal with chronic conditions. If you or a covered family member has a chronic condition, like diabetes or hypertension, speak with a UMR representative about your options at 866.575.2540.

2019 Medical Coverage Summary

The chart below compares the in-network coverage for all three medical plan options. See Out-of-Network Coverage, below, for coverage when you do not see a UMR network provider.

Out-of-Network Coverage

The Health Savings Plan and Premier Plan offer coverage for out-of-network providers, but your out-of-pocket expenses will be higher than for in-network care. The Classic Plan offers only in-network coverage (except in case of emergency).

Health Savings Plan

Classic Plan

Premier Plan

Out-of-Network Deductibles

Individual

$2,700

No coverage out-of-network, except for emergency

$2,000

Family

$5,400

$4,000

Coinsurance

50%

50%

Out-of-Network Annual Out-of-Pocket Maximums

Individual

$9,700

No coverage out-of-network except for emergency

$9,000

Family

$19,400

$18,000

In-network deductibles and maximums do not count toward your out-of-network deductibles and maximums, and vice versa.

Benefit payments for covered services received out of network will be based on the Maximum Allowable Payment, as determined by UMR. Charges in excess of the Maximum Allowable Payment do not count toward meeting the annual deductible or meeting the limitation on your coinsurance maximum. Out-of-network providers may bill you for amounts in excess of the Maximum Allowable Payment.